scholarly journals Effect of PNF and NDT Bobath Concepts on Ischemic Strokes Patients for Trunk Rehabilitation – A Randomized Pilot Study

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Michał Kuciel ◽  
Sebastian Rutkowski ◽  
Patryk Szary ◽  
Paweł Kiper ◽  
Anna Rutkowska
Keyword(s):  
Ischemic Stroke ◽  
Stroke Rehabilitation ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Group Analysis ◽  
Study Groups ◽  
Evidence Based ◽  
Therapeutic Approaches ◽  
Proprioceptive Neuromuscular Facilitation ◽  
Final Measurement

Introduction: Recently, various systematic reviews and evidence-based clinical practice guidelines have evaluated the efficacy of stroke rehabilitation interventions. Across them proprioceptive neuromuscular facilitation (PNF) and neuro-developmental treatment (NDT) Bobath resulted to be an effective and widely used therapeutic approaches. Objective of the work: The aim of the study was to evaluate the therapeutic effectiveness of PNF and NDT Bobath concept for improvement of trunk motor control in patients after ischemic stroke. Materials and methods: The study consisted of 30 patients up to 3 months after ischemic stroke. Participants were randomly assigned to two study groups. Both group consisted of 15 patients underwent rehabilitation according to the PNF or NDT Bobath concept. Comparison of the changes in the Trunk Impairment Scale was the primary outcome. Results: The analysis of the values of total TIS scale showed a statistically significant improvement in both group. Within group analysis showed statistical significance among baseline and intermediate measurement, and among baseline and final measurement within both groups. The analysis of total TIS scale indicators between the PNF and Bobath groups showed no statistically significant differences. Conclusions: Both the PNF and Bobath concepts have proven to be effective in the treatment of posture control and there have been significant improvements in patients from both groups.

Abstract WP440: Stay at Home With Home Care: The Evidence for Readmission Reduction With Home Visits After Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ann M Leonhardt-Caprio ◽  
Craig R Sellers ◽  
Thomas V Caprio
Keyword(s):  
Ischemic Stroke ◽  
Literature Review ◽  
Best Practices ◽  
Home Care ◽  
Hospital Readmissions ◽  
Study Groups ◽  
Care Utilization ◽  
Evidence Based ◽  
Comprehensive Stroke Center ◽  
Meta Analyses

Background: Following hospitalization due to ischemic stroke (IS), 14.4% of Medicare recipients are readmitted within 30 days. Readmission after IS is associated with increased mortality, disability, and elevated costs. Purpose: To identify evidence-based practices to guide reduction of all-cause, 30-day hospital readmissions following IS in a comprehensive stroke center (CSC). Methods: A literature review focusing on readmissions in IS patients was performed using the PubMed, CINAHL, Embase, and Web of Science databases. Search terms: hospital readmission, IS, transition of care, and care transition. Limitations included English publications in the last 5 years. The 39 articles and abstracts reviewed included 2 meta-analyses, 4 literature reviews, 2 randomized controlled trials, 2 qualitative studies, 2 program evaluations, 2 design descriptions without results, and the remainder observational and cohort studies. Most studies were single site or limited geographic areas. Differing patient populations, definitions, and study methods limited the ability to combine results. Literature review results were then compared with baseline practices at our CSC. Results: While multiple best-practices were in place at our CSC, only 44% of IS patients were being referred to home care. Six of the publications reviewed identified home care as a successful component in reducing readmissions within 30 days, reporting statistically significant reduction in readmission rates ranging from 30% to 93% with 3 of 6 reporting p< .05, treatment effect of 1.7 reported by 1, and 2 study groups did not report significance of findings. Conclusions: Reducing readmissions for IS improves outcomes and is a focus of quality efforts across the nation. Using literature, we identified a gap in current best practices (the under-utilization of home care referrals) in our CSC. Despite limitations in the literature, there is clear evidence that the use of home care has reduced readmissions in multiple settings. This has been a successful first step in guiding development of an evidence-based readmission reduction program. An initiative to increase home care utilization at our CSC is currently under evaluation. More study is needed on home care use in the stroke-specific population.

scholarly journals Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1257-1262 ◽  
Author(s):  
Lucie A. van den Berg ◽  
Diederik L.H. Koelman ◽  
Olvert A. Berkhemer ◽  
Anouk D. Rozeman ◽  
Puck S.S. Fransen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
General Anesthesia ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Stroke Severity ◽  
Good Clinical Outcome ◽  
Anterior Circulation

Background and Purpose— Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT. Methods— All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus. Results— Three hundred forty-eight patients were included in the analysis; 70 patients received GA and 278 patients did not receive GA. Non-GA was significantly associated with good clinical outcome (odds ratio 2.1, 95% confidence interval 1.02–4.31). After adjusting for prespecified prognostic factors, the point estimate remained similar; statistical significance, however, was lost (odds ratio 1.9, 95% confidence interval 0.89–4.24). Conclusions— Our study suggests that patients with AIS of the anterior circulation undergoing IAT without GA have a higher probability of good clinical outcome compared with patients treated with general anesthesia.

Trend of Regular Voluntary Blood Donation and its Associated Factors in Karachi - A Comparative Analysis of Medical and Non-medical Undergraduate Students

2020 ◽  
Author(s):  
Nazish Jaffar
Keyword(s):  
Medical Students ◽  
Undergraduate Students ◽  
Blood Donation ◽  
Statistical Significance ◽  
Study Groups ◽  
Medical Group ◽  
Cross Sectional ◽  
Blood Donations ◽  
Medical Undergraduate ◽  
Donated Blood

Background: Regular voluntary unpaid blood donation assures safe blood supply in association with minimum infection transmission. The purpose of this study was to identify the frequency of regular voluntary blood donation and to evaluate the causes of donating blood as well as factors impeding blood donations among the medical and nonmedical students of Karachi. Methods: A comparative cross sectional study was conducted among medical and nonmedical students of JSMU and NED University respectively from May to October 2018. Sample size was 272 including 137 medical and 135 non-medical students. Data was analyzed using SPSS version 22.0. Chi-square test of independence/ Fischer’s exact test were applied to assess statistical significance. Result: In medical group 5/21(23.8%) voluntary regular donors were recorded. In non-medical group, voluntary regular donors were found to be 8/30 (26.6%) (p>0.00). Medical students most commonly 15/21 (71.4%) donated blood voluntarily in a camp while non-medical participants frequently donated blood as replacement donors 13/30 (43.3%) (p>0.00). Major hindering factor for blood donation in both study groups was non-participation in blood donation derives i.e. 66/116 (56.8%) in medical and 53/105 (50.4%) in non-medical groups respectively. Anemia, 20/116 (17.2%) in medical and 15/105 (14.2%) in nonmedical students was the second major cause of not donating blood. Conclusion: The frequency of regular voluntary blood donations is very low among undergraduates. However, comparatively, the trend is slightly higher among non-medical group. The major hindrance in not donating blood was non-participation in blood donating derives.

33 An Evidence Based Laser Therapy Algorithm for the Treatment of Burn Scars

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S26-S27
Author(s):  
Rajiv Sood
Keyword(s):  
Laser Treatment ◽  
Laser Therapy ◽  
Co2 Laser ◽  
Statistical Significance ◽  
Evidence Based ◽  
Baseline Measurement ◽  
Burn Scar ◽  
Therapy Algorithm ◽  
Laser Treatments ◽  
The Impact

Abstract Introduction Hypertrophic scarring after burn injury can be extremely painful, cause profound itching, and affect the way patients view themselves and how the outside world perceives them. We have utilized laser therapy as a modality for scar modulation for our patients since 2013. In 2014, we initiated and completed a prospective IRB approved study to evaluate the outcome of scars treated with fractional CO2 laser therapy (FLT) utilizing objective and subjective tools. Recently, we have completed a prospective study evaluating the use of pulse dye laser (PDL) therapy and the impact on post-burn pruritis. In reviewing the outcomes from these two studies, we have developed an evidence-based laser therapy algorithm for burn scar management. Methods The FLT study entailed a series of three CO2 laser treatments minimally 4–6 weeks apart with scar measurements and POSAS form completion performed prior to each laser treatment and four weeks after the last FLT. Scar measurements that included color, pliability, and scar thickness; and completion of the POSAS form were obtained prior to each laser therapy session and four weeks after the third laser treatment. The measurements of color, pliability, and scar thickness were measured with the Colorimeter, Cutometer, and ultrasound. The PDL study utilized the 5-D Itch scale to evaluate post-burn pruritis. A baseline measurement was obtained prior to any laser treatments. Each patient underwent two PDL sessions and a 5-D itch scale was completed four to six weeks after the second PDL session. The baseline measurement was then compared to the final 5-D itch scale measurement. Results Data from the FLT study is in Table 1 and shows that there were statistically significant improvements in the Patient and Observer POSAS scores, patient rated Itch score, scar thickness, and measured skin density. Changes to patient rated scar pain, scar color, and pliability were noted but were not of statistical significance. Data from the PDL study is in Table 2 and shows a statistically significant decrease in the treated patients’ post-burn pruritis. Conclusions In reviewing the outcomes of these two studies, we have developed an algorithm based on our studies. All of our patients undergoing laser therapy receive two PDL sessions that are four to six weeks apart followed by 3 FLT sessions. The use of both PDL and FLT decreases post-burn pruritis, decreases scar thickness, decreases pain, and increases patient satisfaction as shown in our research.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

2021 ◽  
pp. 159101992110259
Author(s):  
Kainaat Javed ◽  
Santiago R Unda ◽  
Ryan Holland ◽  
Adisson Fortunel ◽  
Rose Fluss ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Flow Diversion ◽  
P Value ◽  
Hemorrhagic Complication ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Complications ◽  
Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

scholarly journals Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis

2021 ◽  
pp. 37-43
Author(s):  
Hediyeh Baradaran ◽  
Alen Delic ◽  
Ka-Ho Wong ◽  
Nazanin Sheibani ◽  
Matthew Alexander ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Goodness Of Fit ◽  
Primary Outcome ◽  
Stroke Risk ◽  
Secondary Analysis ◽  
Predictor Variables ◽  
Baseline Model ◽  
Fit Statistics ◽  
Ischemic Stroke Risk

Introduction: Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk. Methods: In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model. Results: We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics. Conclusions: In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.

Safety of early anticoagulation in patients treated with urgent reperfusion for acute ischemic stroke related to non-valvular atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Giustozzi
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Primary Outcome ◽  
Oral Anticoagulants ◽  
Early Recurrence ◽  
Optimal Timing ◽  
Hemorrhagic Event

Abstract Background The optimal timing for starting anticoagulation after an acute ischemic stroke related to non-valvular atrial fibrillation (AF) remains a challenge, especially in patients treated with systemic thrombolysis or mechanical thrombectomy. Purpose We aimed to assess the rates of early recurrence and major bleeding in patients with acute ischemic stroke and AF treated with thrombolytic therapy and/or thrombectomy who received oral anticoagulants for secondary prevention. Methods We combined the dataset of the RAF and the RAF-NOACs studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and AF treated with either vitamin K antagonists (VKAs) or new oral anticoagulants (NOACs). Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Results A total of 2,159 patients were included in the RAF and RAF-NOACs trials, of which 564 patients (26%) were treated with urgent reperfusion therapy. After acute stroke, 505 (90%) patients treated with reperfusion and 1,287 out of the 1,595 (81%) patients not treated with reperfusion started oral anticoagulation. Timing of starting oral anticoagulation was similar in reperfusion-treated and untreated patients (13.5±23.3 vs 12.3±18.3 days, respectively, p=0.287). At 90 days, the composite rate of recurrence and major bleeding occurred in 37 (7%) of patients treated with reperfusion treatment and in 139 (9%) of untreated patients (p=0.127). Twenty-four (4%) reperfusion-treated patients and 82 (5%) untreated patients had early recurrence while major bleeding occurred in 13 (2%) treated and in 64 (4%) untreated patients, respectively. Seven patients in the untreated group experienced both an ischemic and hemorrhagic event. Figure 1 shows the risk of early recurrence and major bleeding over time in patients treated and not treated with reperfusion treatments. The use of NOACs was associated with a favorable rate of the primary outcome compared to VKAs (Odd ratio 0.4, 95% Confidence Interval 0.3–0.7). Conclusions Reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with AF-related acute ischemic stroke who started anticoagulant treatment. Figure 1 Funding Acknowledgement Type of funding source: None

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